Archived: Eden Medical Group

Updated 4 February 2016

Eden Medical Group is registered with the Care Quality Commission to provide primary care services. The practice provides services to approximately just over 15,200 patients from one location, Eden Medical Group, Port Road, Carlisle, CA2 7AJ, which we visited as part of this inspection.

Eden Medical Group is a large practice providing care and treatment to patients of all ages, based on a General Medical Services (GMS) contract. It is situated in the north of Carlisle and is easily accessible by road or public transport. There is a designated car park for the practice. The practice is part of the NHS Cumbria clinical commissioning group (CCG).

Information taken from Public Health England placed the area in which the practice was located in the fifth most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. There was a slightly higher proportion of people in the area in paid work or full time employment at 62.8% (compared to an England average of 60.2%). The unemployment rate in the area is much lower than the National average at 1.8% (compared to the national average at 6.2%). There were a higher proportion of disability allowance claimants (at 61.3 per 1000 population, compared to an England average of 50.3 per 1000 population).

The age distribution in the practice areas reflected the national average, although with slightly higher percent over the age of 65+ years. The average male life expectancy is 79 years, which is the same as the England average. The average female life expectancy is 82 years, which is slightly lower than the England average of 83 years.

The percentage of patients reporting with a long-standing health condition is slightly higher than the national average (practice population is 55.5% compared to a national average of 54.0%). The percentage of patients with health-related problems in daily life is similar to the national average (48.7% compared to 48.8% nationally). There are a higher percentage of patients with caring responsibilities at 20.8% compared to 18.2% nationally.

The practice has seven GP Partners, of which three are male and four are female. Some of these partners were in the process of applying to join the partnership through the CQC registration process. There is also one male and one female salaried GP. There is a nurse manager, a nurse practitioner, four practice nurses, three healthcare assistants and a team of administrative support staff.

There was no CQC registered manager at the practice at the time of the inspection. We spoke with practice staff about this, who told us an application was underway and would be submitted to CQC shortly to register Dr King as the registered manager.

The opening times for the practice are as follows:

• Monday 8:00 am - 8:00 pm
• Tuesday 8:00 am - 8:00 pm
• Wednesday 8:00 am - 6:30 pm
• Thursday 8:00 am - 6:30 pm
• Friday 8:00 am - 6:30 pm

The consulting appointment times are:

• Monday 8:30 - 11:10am and 2:30 - 7:50pm
• Tuesday 8:30 - 12:30pm and 2:30 - 7:50pm
• Wednesday 8:30 - 12:30pm and 2:30 - 6:20pm
• Thursday 8:30 - 12:30pm and 2:30 - 6:20pm
• Friday 8:30 - 12:30pm and 2:30 - 6:20pm

The service for patients requiring urgent medical attention out of hours is provided by the 111 service and Cumbria Health on Call (CHOC).

Updated 4 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eden Medical Group on 24 and 30 November 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• The practice had made improvements to make it easier for patients to get through to the practice by phone and make an appointment. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

• The practice had implemented strong arrangements for managing the performance of staff. We saw all staff had a folder which included their core objectives, personal development plan and all the standards associated with their role. This helped to ensure staff were aware of what was expected of them and had ready access to guidance related to the tasks and duties they were responsible for. The approach focused on skills identification to ensure the practice had the right staff in place with the right skills. This helped ensure a sustainable future for the practice.

The areas where the provider should improvement are:

• Assess and review the arrangements in place for the practice to meet the needs of patients with hearing impairment; to ensure they have good access to the practice and its services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 February 2016

The practice is rated as good for the care of people with long-term conditions.

• Effective systems were in place which helped ensure patients with long-term conditions received an appropriate service which met their needs. These patients all had a named GP and received an annual review to check that their needs were being met. For those people with the most complex needs, the named GP worked with other relevant health and care professionals to deliver a multidisciplinary package of care.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group. For example, the percentage of patients aged 8 or over on the asthma register, with measures of variability or reversibility recorded between 3 months before or any time after diagnosis was 90.1%, which was higher than the local average of 89.2% and the national average of 88.4%. The practice had plans in place as to how they would address areas of lower performance.
• Longer appointments and home visits were available when needed.
• Patients at risk of hospital admission were identified as a priority, and steps were taken to manage their needs.
• Staff had completed the training they needed to provide patients with safe care.

Updated 4 February 2016

The practice is rated as good for the care of families, children and young people.

• Regular weekly baby clinics were held by practice staff. The GP partners provided support to the baby clinics. We saw good examples of joint working with midwives, health visitors and school nurses.
• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
• Childhood immunisation rates for the vaccinations given were comparable to clinical commissioning group (CCG) and national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 84.6% to 96.0% and five year olds from 71% to 98.1%. The majority were around the same as the local CCG averages. The average percentage across the CCG for vaccinations given to under two year olds ranged from 83.3% to 96.0% and five year olds from 72.5% to 97.9%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. We saw there were information boards in the practice waiting area aimed at the needs of children and young people.
• Where appropriate, younger patients were able to access contraceptive and sexual health services, and appointments were available outside of school hours.
• Nationally reported data showed the practice had performed in line with average for providing recommended care and treatment for this group of patients.

Updated 4 February 2016

The practice is rated as good for the care of older people.

• Staff provided proactive, personalised care which met the needs of older patients. Patients aged 75 and over had been allocated a named GP to help ensure their needs were met.
• Good arrangements had been made to meet the needs of ‘end of life’ patients. Staff held regular palliative care meetings with other healthcare professionals to review the needs of these patients and ensure they were met.
• The practice offered home visits and longer appointment times where these were needed by older patients.
• Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group. 80.6% of patients aged 65 years or over received a seasonal influenza vaccination which was better than the national average (of 73.2%).

Updated 4 February 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice had assessed the needs of this group of patients and developed their services to help ensure they received a service which was accessible, flexible and provided continuity of care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Nationally reported data showed the practice the practice provided recommended care and treatment that was in line with national averages for this group of patients. For example, bowel cancer screening rates within 30 months, for patients aged 60-69 was 60.8%, which was slightly lower than the national average of 63.9%.

Updated 4 February 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Nationally reported data showed the practice had performed higher than comparators in providing recommended care and treatment to patients with mental health needs. For example, the practice achieved 100% of the points available in this area. This compared to an average performance of 95.4% across the clinical commissioning group (CCG) and 92.8% national average. 96.1% of patients with schizophrenia, bipolar affective disorder and other psychosis had a comprehensive agreed care plan documented within the preceding 12 months. This compared to a national average of 88.4%.
• 84% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months (compared to a national average of 84%).
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• They had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 4 February 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including patients with learning disabilities.
• Staff carried out annual health checks for patients who had a learning disability and offered longer appointments.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• Staff provided vulnerable patients with information about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff understood their responsibilities regarding information sharing, the documentation of safeguarding concerns and contacting relevant agencies.